Provider Demographics
NPI:1477545309
Name:ST MARTIN, KRISTI LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNNE
Last Name:ST MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MEDICAL CENTER BLVD.
Mailing Address - Street 2:ATTN: HOSPITALIST DEPARTMENT
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-0000
Mailing Address - Country:US
Mailing Address - Phone:504-349-1656
Mailing Address - Fax:504-349-1933
Practice Address - Street 1:1101 MEDICAL CENTER BLVD.
Practice Address - Street 2:ATTN: HOSPITALIST DEPARTMENT
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-0000
Practice Address - Country:US
Practice Address - Phone:504-349-1656
Practice Address - Fax:504-349-1933
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024635207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1573949Medicaid
LA1573949Medicaid
LA4J707Medicare PIN